The nailing of shaft fractures of long bones without exposure of the fracture site was first advocated by Dr. Kuntscher in the 1940's. With the development of image intensifier television fluoroscopy, which reduces the amount of radiation necessary during the procedure, has led to wide acceptance of the closed nailing method. The typical procedure as presently practiced, and as particularly used for the femur bone in the thigh is as follows:
(1) The patient is positioned on a fracture table in a lateral position.
(2) A tibial traction pin is inserted.
(3) A traction force is placed across the tibial pin.
(4) Fluoroscopy is used to visualize the fracture site and to insure that the femur is out to length--i.e., the fracture ends are not overlapping.
(5) An awl is used to enter the medullary canal in the upper part of the femur (near the hip).
(6) A flexible guide wire is inserted and advanced to the fracture site.
(7) External pressure is applied to the exterior of the thigh to force the portions of the femur into alignment using fluoroscopy to guide the physician. Typically, this is accomplished by use of an unsterilized crutch or the like. An alternate approach is disclosed in U.S. Pat. No. 4,558,697 "Method and Apparatus for Setting Fractures" by K. K. Wu. Here, a pair of hook like members are used to externally manipulate the thigh while the fracture site is under X-ray. These hooks have a sufficient length such that handles at the opposite end can be used for manipulating the hook ends from a point out of the exposure range of the X-ray. These hooks have the additional advantage of being easily sterilized.
(8) The guide wire is thereafter advanced across the fracture site of the aligned segments of the femur to the end thereof.
(9) A reamer is inserted and the canal is reamed its entire length--i.e. the reamer has a central hole through which the wire extends and is guided thereby.
(10) Thereafter, the reamer is removed and the nail is inserted into the reamed hole, again using the wire as a guide.
(11) The guide wire is thereafter removed and the surface opening closed.
The main advantage of the closed nailing procedure is obvious, i.e., the fracture site is not exposed. However, the above procedure is not without problems for it is often difficult to align segments of the broken bone by use of only external manipulation. Often exposure of the fracture site to visualize and obtain proper alignment is required.
Thus, it is a primary object of the subject invention to provide a method and tool for setting fractures which eliminates the need for direct exposure of the fracture site.
It is another object of the subject invention to provide a method and tool for closed nailing of fractured bones that can achieve alignment of the fractured bone portions without external manipulation of the limb or at least greatly reducing the need for such external manipulation.